4 Australian rheumatology highlights from APLAR 2021

Thursday, 23 Sep 2021

The Asia Pacific League of Associations for Rheumatology (APLAR) delivered “cutting-edge” scientific and clinical content virtually at this year’s APLAR 2021 annual meeting, hosted in Kyoto. We’ve curated some of the conference’s key Australian poster presentations to support your practice.

Fibromyalgia common in patients six months post COVID-19 infection

COVID-19 patients can experience fibromyalgia, ‘fibromyalgianess’ and fatigue six months post infection, according to a Victorian study.

Of 25 patients studied six months post COVID-19 infection, five met widespread pain index (WPI) and symptom severity scale (SSS) criteria for fibromyalgia and three had polysymptomatic distress (PSD) scores >12, suggesting severe symptoms, the researchers from Austin Health, Melbourne, wrote.

Problematic fatigue was reported in nine patients (mean 9-item, 7-point fatigue severity scale [FSS] score >4) and, although not statistically significant, occurred more frequently in females than males (56% vs 25%, 95% CI: -9% to 71%) and in patients under 60 years (46% vs 25%; CI -16% to 58%).

Female patients also had a statistically significant higher mean WPI (8.0 vs 2.0), SSS (7.0 vs 2.1) and PSD (15.0 vs 4.1) than men.

“Six months following COVID-19 infection, fibromyalgia, ‘fibromyalgianess’ and fatigue are common, with higher frequency in females and younger patients,” the authors wrote.

“This pattern parallels conventional fibromyalgia cohorts and may favour targeted service delivery.”

More research is needed to determine whether the symptoms persist long-term, they concluded.

Hospital stays longer for gout patients with impaired mobility and high CRP levels increase 

Gout hospitalisations are increasing, and impaired mobility and high C-reactive protein (CRP) levels are lengthening their stay, Sydney-based researchers have shown.

A retrospective study of 62 patients admitted to Royal Prince Alfred Hospital with a primary diagnosis of gout in 2019 showed the average length of stay was 3.36 days — double the 2013–2014 Australian average.

Impaired mobility and higher CRP levels were “significantly associated with a longer length of stay” (moderate effect size on the LOG [LOS] R2=0.44, respective coefficients of 0.44, 95% CI: 0.22–0.61, P < 0.0001 and 0.002, 95% CI: 0.0012–0.0027, P < 0.0001), the authors wrote.

Hospitalisations for primary and secondary gout flares have been increasing with 1.03 gout episodes per 1,000 total hospital admissions.

“Few studies have analysed factors associated with length of stay in hospitalised gout patients and where they have, have mainly focused on patient related factors, rather than the severity of the gout flare itself,” the authors wrote.

This study showed mobility impairment and higher CRP levels “are associated with longer length of stay during acute gout attacks requiring hospital admission”, they concluded.

Lower proteinuria aids lupus nephritis remission and flare reduction

Lupus nephritis patients have a better chance of achieving remission when significantly decreasing proteinuria levels, Queensland-based researchers have found.

A 5-year study of 33 lupus nephritis patients in varying remission states (none to complete), showed 73% of those in complete remission at three months and 77% at six months had an 85% drop in proteinuria, while none of the patients with active disease at six months achieved such a reduction.

Patients in complete remission reduced proteinuria by 51% (rate 0.49, 95% CI: 0.42–0.58) and 39% (rate 0.61, 95% CI: 0.55–0.69) per month, respectively at three and six months. Those without flares saw a 32% and 15% reduction per month at three and six months, and patients with active disease, 20% and 3% respectively, the authors from The Prince Charles Hospital and QIMR Berghofer Medical Research Institute wrote.

Remission is more likely in lupus nephritis patients who achieve significant proteinuria decreases within three to six months, they said.

“Also, patients with greater decline in proteinuria in the first 3-6 months showed lesser number of flares in the 5-year period,” they concluded.

Giant cell arteritis onset more common in cooler months 

Giant cell arteritis (GCA) seasonality has been hotly contested, but a Victorian study has added weight to the idea that cooler weather could contribute to disease flares.

A study of 194 individuals who underwent temporal artery biopsy from 2011 to 2020 showed patients were more likely to see GCA symptoms in autumn and winter versus summer and spring (odds ratio 2.36, 2.13 and 1.95 in autumn, winter and summer versus spring, respectively).

“Notably, there was a mean delay from symptom onset to biopsy of 37.2 (SD ± 38.4) days,” they wrote.

Overall, 45 patients had positive biopsy results and 19 were diagnosed with biopsy-negative GCA, the authors from Austin Health wrote.

Though previous studies have had conflicting results regarding seasonality and GCA, this study “demonstrated a predilection for GCA symptom onset in the autumn and winter in a temperate Southern Hemisphere setting”, they added, noting that conflicting data may be due to differences in GCA ascertainment and disease onset.

“More robust studies of large patient populations across multiple geographic locations may shed light on seasonality as a risk factor for GCA,” they concluded.

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